Provider Demographics
NPI:1780686683
Name:LANDRY, BARRY G (MD)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:G
Last Name:LANDRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:604 NORTH ACADIA RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301
Mailing Address - Country:US
Mailing Address - Phone:985-446-1763
Mailing Address - Fax:985-446-9813
Practice Address - Street 1:604 NORTH ACADIA RD
Practice Address - Street 2:SUITE 207
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301
Practice Address - Country:US
Practice Address - Phone:985-446-1763
Practice Address - Fax:985-446-9813
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2010-10-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA016229208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1345041Medicaid
LA1345041Medicaid
LA5F910Medicare ID - Type Unspecified
B61522Medicare UPIN